Attention and Activity Level

Maureen Mulligan LaRossa, R.N.

Infants and very young children move constantly from one object or experience to another and are generally energetic and curious.  As children get older we expect them to spend more time focusing their attention on a single task, making smooth transitions from task to task, and following rules and requests.  For some children the movement along this continuum is slower than it is for others.  For some children the ability to stay on task will always be a challenge.  A frequent concern expressed by parents of preemies is that their child is very impulsive and frequently overreacts to the environment.  Some children will slowly improve their skills, but there will be others for whom impulse control, focusing attention, and/or a high activity level will persist as issues that need to be addressed as they grow.

There are a number of reasons why an infant or very young child may be having difficulty focusing their attention or controlling their impulses and/or their activity level.  Some of these reasons include vision problems, hearing problems, sensory issues, anxiety and attention deficit disorder (ADD).

Vision and Hearing Problems:

Problems with a child’s ability to see and hear should always be ruled out first when developmental problems are suspected.  Difficulties in these areas may make it hard for a child to follow instructions or become engaged with materials.  Such children often appear disorganized and their behavior can be interpreted as willful and uncooperative when in reality the child is unaware of what is expected.  An evaluation by a Pediatric Audiologist or Pediatric Ophthalmologist should be discussed with the child’s primary health care provider.

Sensory Issues:

Some children will over react to their environment because of sensory problems.  They may perceive sounds, sights or touch differently than most children.  They may even perceive sensations that many children find comforting as annoying or painful.  These children may respond through sensory seeking behaviors or by withdrawing, becoming less responsive.  It can sometimes be helpful to step back and try to figure out what is motivating a child’s behavior.  One approach is to jot down daily, over a week, what happens just before disruptive behaviors occur, and also what happened immediately after the behavior.  Reviewing your notes may allow you to pick up a pattern that gives you clues about how to avoid, or work, with these problems.   Sometimes parents find an occupational therapist with experience in sensory problems can be a helpful guide in working with their child.

Problems for children with sensory issues can include negative reactions to seams in their clothes, or to the feel of certain types of material against their skin.  Some children find light stroking, a form of touch that comforts many children, to be an annoying and upsetting sensation.  These children may respond more favorably to slow, firm, deep pressure stroking.  Do not assume the child does not like to be touched.  All humans need physical contact.  The challenge is to find out what works for each child.  Some infants will become calm when swaddled with a blanket while others will find swaddling upsetting.  Some children are very particular about what they touch with their hands and/or feet.  This can limit the types of materials or types of play they experience which, in turn, can influence their learning.

Some children with sensory problems respond well to a combination of comfort and encouragement.  The parents’ recognition of how difficult it is for the child to attempt certain tasks, or deal with certain situations, can be comforting.  Parental encouragement of the child to continue to try to overcome difficulties and master a skill or situation can be very helpful to the child.  A task may have to be broken into its component parts and each tried separately before a child will master the whole task.  A social situation may need to be structured for the child.  For example, a child may get upset and become increasingly active and disorganized at a party when too many people are trying to interact with him in a short period of time.  A parent may try getting to the gathering early.  This way the child does not have to enter a noisy room full of people.  By being the first people there the activity and noise build slowly.  Having toys of his own to play with in a quiet corner of the room, with a parent close by, may make the situation tolerable.  Asking the adults to wait and let the child come to them when he feels comfortable, rather than the adults "intruding" on the child, can also be helpful.  Be ready to leave early if the child starts to get overwhelmed.  The goal is to build on small successes, increasing and expanding the child’s tolerance slowly over time. 

Anxiety:

Most people think of anxiety and/or depression as causing withdrawal or inactivity. However, some infants and very young children respond to anxiety and depression by increasing their activity level, which then makes it more difficult for them to focus their attention.  One common cause of anxiety and depression in young children involves issues of loss and separation.  Life events that may result in a child experiencing anxiety and/or depression can include: frequent hospitalizations that separate a child from her family and routines, marital separation or divorce which results in sudden, significant decrease in contact with one of the parents, and death or severe illness of a significant caregiver. 

Attention Deficit Disorder:

Some children come into this world busy, impulsive and/or easily distracted.  Once they become upset they may be difficult to console.  As infants these children may have trouble moving smoothly from sleep to an alert state.  They may be what is referred to as the "one-five kids."  They go from deep sleep (state 1) to screaming (state 5), bypassing light sleep, drowsy, and alert states.  As toddlers they are in constant motion, into everything, and do not appear to learn rules as easily as most children.  They seem to leap before they think.  Many very young children behave this way at some time in their development and to some degree.  These behaviors occur along a continuum.  Also, as mentioned above, there can be a number of causes for a child’s behavior that need to be addressed.  However, for some children these other causes may not apply or may not fully explain the behavioral picture.  When referring to the behavior of infants and very young children the diagnosis of attention deficit disorder (ADD), in most cases, would not be made.  Generally children do not receive this label before school age, a time when children are expected to significantly increase their ability to focus attention and control impulses.  The child with ADD has difficulty meeting these increasing demands.  There are websites that address ADD in much greater detail than we can here (see below). 

In addition to addressing the issues of vision, hearing, sensory integration and/or anxiety there are many things you as parents can do to help your child.  There are activities and ways of interacting with young children that may help them learn to attend for longer periods of time.  For some children, with maturation, there is a gradual lengthening of the ability to attend and a decrease in impulsivity, and by the time the child enters school he/she can handle a classroom setting.  For a small group of children the problems of attention and impulsivity will persist.  The suggestions that follow are good for all children and may be of particular help to busy, impulsive children regardless if at some later date they are or are not found to have ADD.  Attention worksheet #1 Routines, Attention Worksheet #2 Structured Play, Attention Worksheet #3 Reading.

For further discussion of ADHD  click here.   For suggestions to help the frequently hospitalized child click here.